Clerkship Grades...

[battleship888]

Sorry to make this its own thread, but my frustration is starting to get to me more and more on this topic. Clerkships are worth 50% of our grade, and the discrepancy and complete randomness in grading is just becoming so unbelievable I do not see the accountability. I know this may not be unique to my school, but when 60% is considered average for your clinical grade, how does this make any sense? I managed only a pass in Psychiatry while getting over 90% on the shelf and it is my number one choice for specialty.

If I received some of the scores my other classmates received I would have honored and not even have high passed. I barely missed honoring Medicine already because of the luck of the draw with the attendings we are assigned, and I get there is going to subjectivity, but this is just getting ridiculous.

I am okay with bad luck or life not being fair, but after reading a few threads and topics on this, what program directors could honestly think these grades mean anything? I think my school reports NBME scores and all my comments have been good, but I could definitely see this not passing the eye test, although my Step 1 and hopefully Step 2 will be pretty above average.

This was part venting, and part just trying to get an idea of how these things look. Its frustrating to be the only student with a certain attending and end up with one of the lowest grades on the rotation, based on pretty much nothing.

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[Merovinge]

Not sure what to tell you other than Yes. It is arbitrary, it does suck. On the plus side if you are planning on doing psychiatry the clerkship grades will not make/break you (be grateful your life dream isn't derm as that would already be over).

The students who did best with clerkship grades were folks whose friend/family could tell them what preceptors to request that graded cush (or better yet their parents had the preceptor over for dinner...). Also, finding non-obvious ways to connect with the person grading you makes a huge difference. This lets you put those psych skills to the test! I was godawful on surgery but genuinely liked the attending who had the biggest part of my grade and he completely saved my performance, so it can definitely go both ways.

 

[postbacpremed87]

Same boat, Step 1 Score around 240, solid Psych ECs...only High Pass in Psych though (honored Shelf only passed actual rotation). We will match....at least that's what I am telling myself

 

[battleship888]

I really do appreciate the responses, and I hate talking about this stuff since, even to me, it just sounds like whining. Its weird to wonder what a PD might have running through their head at a top 10-20 program if they see only a Pass in Psych, which probably puts me at the bottom 20-25% in my class for that clerkship or something. This is still with good comments from this same attending and a great shelf and everything. Oh well.

Yeah I am around 240 on Step 1 too and was hoping this would be fine for one of the top Midwest programs like UPMC or UofM along with grades, letters and what not. Its just really annoying.

 

[psychhopefull2016]

Guys. Take a couple psych electives and do well in them. A good friend of mine didn't do stellar in their psych rotation and has interviews at a bunch of fancy programs including one of the ones you mentioned!

Make sure to do your psych electives/Sub-Is early so they are on your transcript and can be used for letters!

 

[Merovinge]

I really do appreciate the responses, and I hate talking about this stuff since, even to me, it just sounds like whining. Its weird to wonder what a PD might have running through their head at a top 10-20 program if they see only a Pass in Psych, which probably puts me at the bottom 20-25% in my class for that clerkship or something. This is still with good comments from this same attending and a great shelf and everything. Oh well.

Yeah I am around 240 on Step 1 too and was hoping this would be fine for one of the top Midwest programs like UPMC or UofM along with grades, letters and what not. Its just really annoying.

Biggest trick is to not get phased. I was so down after just passing my (at the time) desired field's clerkship. I happened to get great psych attendings/residents immediately thereafter and revitalized my interest/passion for medicine in general (as well as set me up for my career). You can absolutely get interviews at UofM and UPMC with a 240 and middling clerkship grades. Do the best you can for the rest of M3 year and know M4 year will actually go well when you work with people who share mutual interests.

Also, UPMC and UofM are great programs but there are many more in the midwest too. UW, MCW, Iowa, UIC, NW and many more are all great too!

 

[thoffen]

I'm recently on the other side of this and honestly have no idea how to fill out the evaluations because I don't know what other people are doing and if someone doesn't have any deficiencies that would prevent them from doing well in residency, I wouldn't want to be a barrier to them.

I would say, though, that if you are doing worse than you expect in the evaluation department, take it seriously.

Very few people are bad residents because they aren't smart enough. The other stuff is subjective and difficult to interpret, but it is by far more important.

 

[battleship888]

I'm recently on the other side of this and honestly have no idea how to fill out the evaluations because I don't know what other people are doing and if someone doesn't have any deficiencies that would prevent them from doing well in residency, I wouldn't want to be a barrier to them.

I would say, though, that if you are doing worse than you expect in the evaluation department, take it seriously.

Very few people are bad residents because they aren't smart enough. The other stuff is subjective and difficult to interpret, but it is by far more important.

Yeah I can see that. I should mention that I can really only blame the system and whoever creates this stuff at my school, and not the evaluators. I also think I really got screwed since I ended up with a preceptor that doesn't get as many students as the others. He gave me a mix of what I think he thought were average and above average scores, which comes out to a failing grade (60-70%) in our system, at least for that half of the grade. I just have no clue how other schools manage this.

 

[Merovinge]

Yeah I can see that. I should mention that I can really only blame the system and whoever creates this stuff at my school, and not the evaluators. I also think I really got screwed since I ended up with a preceptor that doesn't get as many students as the others. He gave me a mix of what I think he thought were average and above average scores, which comes out to a failing grade (60-70%) in our system, at least for that half of the grade. I just have no clue how other schools manage this.

There's not really any formal way to do so. Our school sent out reminders that only 10% of students where to keep the top mark and then another 20-30% for mid mark and the rest satisfactory marks. In reality about 50% of students get the top, 25% the 2nd and 25% the third. However if you get a preceptor who actually follows the guidelines you are dead in the water.

Edit: Medical education needs a LOT of changes. Going into psychiatry is a great way to be involved in that if it is something you are passionate about.

 

[clausewitz2]

I ended up getting a surprisingly high grade on my surgery clerkship because one of the attendings I was working with was famous for a terrible temper.

Seriously.

I was not covering myself particularly in glory, but then one day I was retracting for him on a thyroid case and so I was stood at a really awkward, over-the-patient's-head-angle, and he was getting worked up about some new scrub tech not handing him things in exactly the order he preferred, and he got kind of disgusted and was shouting and reached up and swung the overhead lamp around, hard, so he could step to the other side of the patient and have light. Must have forgotten where I was standing, because he brained me pretty solidly and sent me reeling.

Cue a lot of "hahaha, guess you'll get a good grade now, hahahaha, but seriously please don't tell anyone that happened."

Dude had not acknowledged my existence in the slightest, but for the rest of the year, when I passed him in the hall, he was very smiley and careful to ask after me and how I was doing. I also got a stellar evaluation (And it is not false modesty to say I was not a very good med student on surgery).

Either he had a rep and was on sufficient thin ice that he feared the consequences, or reaction formation FTW.

 

[Monkey House]

The clerkship grade is a data point - but having research in psychiatry or presenting a poster goes further than you imagine too. Doing something with the APA or state chapter / psychiatry leadership is good as well. Much better to work on the full package and solidly demonstrating 'why psych' than to be worried about one single piece.

 

[battleship888]

There's not really any formal way to do so. Our school sent out reminders that only 10% of students where to keep the top mark and then another 20-30% for mid mark and the rest satisfactory marks. In reality about 50% of students get the top, 25% the 2nd and 25% the third. However if you get a preceptor who actually follows the guidelines you are dead in the water.

Edit: Medical education needs a LOT of changes. Going into psychiatry is a great way to be involved in that if it is something you are passionate about.

I just wish there was some type of standard. Hearing about other students' boasts about honoring while going home early everyday and doing nothing, and hardly seeing any patients wears at you when you actually work hard and want to do the specialty.

 

[FlowRate]

Psych can be very forgiving. Impress people on your advanced rotations such that they write truly good letters for you.

 

[tr]

Sorry to make this its own thread, but my frustration is starting to get to me more and more on this topic. Clerkships are worth 50% of our grade, and the discrepancy and complete randomness in grading is just becoming so unbelievable I do not see the accountability. I know this may not be unique to my school, but when 60% is considered average for your clinical grade, how does this make any sense? I managed only a pass in Psychiatry while getting over 90% on the shelf and it is my number one choice for specialty.

So it's actually completely impossible to compare clinical grades directly among candidates from different schools, because different schools have different grading systems (Pass, High Pass, Near Honors, Honors, etc) and different percentages of students that fall into each of those categories. Some schools have only 10% of students honor and others have like 60% honor.

Luckily the dean's letter has to include a graph of the class distribution of scores over the clinical grading system, and where the applicant fell in that distribution. When I interview applicants I just look at that instead of the actual grade. Also because I know about the randomness factor, instead of placing exclusive emphasis on specific rotations like psych and medicine, I try to gestalt whether the applicant generally fell in the top half of the school's distribution for the majority of their clinical rotations. You could always get unlucky with a difficult preceptor so e.g., if an applicant generally did better than most of their classmates for most rotations, a Pass in psych wouldn't be a big deal to me as long as they had good letters. That said, most of our applicants do seem to have honored their psych rotations, which makes sense since people tend to do better at things they like.

In fact when I'm evaluating applicants I would say their grades are not the most important factor in my assessment. Most of our applicants are very good academically anyway so it kind of washes out. I look more at what else they spent their time doing, do they have a passion for some specific goal (could be research, working with the underserved, community action or whatever), were they dedicated to that goal and do they seem like someone who will of course be a solid, reliable, and caring clinician, but also who will push the field forward in whatever direction is of most interest to them.

 

[HarryMTieboutMD]

Honestly unless you are an absolutely standout AOA type person clerkship grades are going to matter very little if you did well on Step 1 and go to a good medical school. Those are the top 2 things by far (which is 1 vs 2 depends on the program, program culture, program director, etc). Clerkship performance is a distant 3rd. 1/2 of the med schools don't even grade or use an arbitrary honors/high pass/whatever system.

I'm impressed by AOA and flawless performances (the minority btw), but otherwise I don't really care if someone got a B+ in psych because MS3 grading is a game/joke/whatever

 

[battleship888]

So it's actually completely impossible to compare clinical grades directly among candidates from different schools, because different schools have different grading systems (Pass, High Pass, Near Honors, Honors, etc) and different percentages of students that fall into each of those categories. Some schools have only 10% of students honor and others have like 60% honor.

Luckily the dean's letter has to include a graph of the class distribution of scores over the clinical grading system, and where the applicant fell in that distribution. When I interview applicants I just look at that instead of the actual grade. Also because I know about the randomness factor, instead of placing exclusive emphasis on specific rotations like psych and medicine, I try to gestalt whether the applicant generally fell in the top half of the school's distribution for the majority of their clinical rotations. You could always get unlucky with a difficult preceptor so e.g., if an applicant generally did better than most of their classmates for most rotations, a Pass in psych wouldn't be a big deal to me as long as they had good letters. That said, most of our applicants do seem to have honored their psych rotations, which makes sense since people tend to do better at things they like.

In fact when I'm evaluating applicants I would say their grades are not the most important factor in my assessment. Most of our applicants are very good academically anyway so it kind of washes out. I look more at what else they spent their time doing, do they have a passion for some specific goal (could be research, working with the underserved, community action or whatever), were they dedicated to that goal and do they seem like someone who will of course be a solid, reliable, and caring clinician, but also who will push the field forward in whatever direction is of most interest to them.

Thank you very much, and I appreciate the other responses as well. I am a little concerned about the distribution, since my guess is that a pass at my school definitely puts me in the bottom half if not much lower. I still feel confident about demonstrating great interest in the field and working towards strong letters and probably another psychiatry rotation/AI before my application goes out so hopefully that makes up for it.

Also, this clerkship grade is by far the lowest grade I have received thus far and while I am probably an AOA candidate right now, this definitely didn't help.

 

[ziggyhope]

Thank you very much, and I appreciate the other responses as well. I am a little concerned about the distribution, since my guess is that a pass at my school definitely puts me in the bottom half if not much lower. I still feel confident about demonstrating great interest in the field and working towards strong letters and probably another psychiatry rotation/AI before my application goes out so hopefully that makes up for it.

Also, this clerkship grade is by far the lowest grade I have received thus far and while I am probably an AOA candidate right now, this definitely didn't help.

Like others have commented, I think it is "normal" for you to feel this way as yes, the system is incredibly frustrating at times, and your entire clerkship experience can be a roll of the dice if your school does it in a way where you only have one or two evaluators per rotation. However, it IS important to be able to work with people with all sorts of personalities, as someone stated previously, not many residents fail because they are not smart enough, many DO fail because of the other factors (such as interacting with others under high stress). This is by no means directed at you, just a general comment. If I were you, I would do Sub-Is as soon as possible, and ace that so when someone looks at your performance/letters/evals, they can see that you can in fact do well. Other than that, no it probably won't limit your chances if everything else on your app is solid.

 

[clozareal]

Clerkships boil down to two things:
1. luck - whether you get a good or bad resident/attending for that rotation
2. test-taking skills - scoring high on the shelf

PDs know that clerkship grades and comments are often unreliable and will weigh it against everything else to evaluate consistency. Now if all your clerkship grades suck, your letters are mediocre, your USMLE scores are low, and you have a dismal number of research or extracurricular activities, even a good reason like a family or working through medical school won't save you from being denied an interview.

 

[battleship888]

Very cool, appreciate all the responses. A little specific but would my NBME psych shelf help since my school reports those? I did very well and was just curious how often those are looked too and if that would also help. I am not really worried or anything especially after everyone's responses and advice, but the grade definitely felt a punch in the gut so I just wanted to clarify a few things.

 

[Merovinge]

Very cool, appreciate all the responses. A little specific but would my NBME psych shelf help since my school reports those? I did very well and was just curious how often those are looked too and if that would also help. I am not really worried or anything especially after everyone's responses and advice, but the grade definitely felt a punch in the gut so I just wanted to clarify a few things.

Test scores are a bit weird I think in psych. I know personally that given my piss-poor USMLE step 1 score it helped that I was a 99% on the psych shelf (or so I have heard from attendings). I think in general it isn't a huge deal but people do take note if you crush the subject like it sounds like you did. Same thing with PRITE when you get to residency, doesn't really matter much but if you are crushing the exams people talk and it does reflect positively (IMO).

 

[tr]

Uh, I don't even think I see the shelf scores listed separately from the rotation grade on these residency applications. I think they just figure into the final grade? Honestly I forgot how the shelves are scored so it wouldn't mean much to me either.

 

[battleship888]

Uh, I don't even think I see the shelf scores listed separately from the rotation grade on these residency applications. I think they just figure into the final grade? Honestly I forgot how the shelves are scored so it wouldn't mean much to me either.

Yeah I have heard and read different things, and was told by a classmate that ours are reported separately and were on their application. I was surprised. I assume it depends on the school but I'm not sure.

 

[OldPsychDoc]

Uh, I don't even think I see the shelf scores listed separately from the rotation grade on these residency applications. I think they just figure into the final grade? Honestly I forgot how the shelves are scored so it wouldn't mean much to me either.

I've seen it both ways on MPSEs, usually as part of the specific comments on individual rotations, not as part of the transcript. It is school-dependent.

 

[Amygdarya]

Shelf score reporting on MSPE depends on the school or even individual rotation. E.g., at my school, in the official clerkship summaries that go into MSPE, some clerkship directors include shelf scores, some can write something like "scored in the top... percent of test takers", some don't mention shelf results at all.

 

[Candidate2017]

Grades are random sometimes but not most times. You have some control. I told everyone (attendings, residents, nurses, and techs) on my psychiatry rotations I wanted to do psychiatry, showed interest, read up on patients, polished my notes and did well on my shelf. Importantly, I got along well and treated everyone as a colleague and people made their desire known for me to do residency there and be a future colleague. Randomness cuts both ways too. I did well on surgery in spite of doing the minimum.

People with a 240 USMLE need to calm down too because SDN neuroticism is rampant.

 

[MacDonaldTriad]

Ok, time to review the interviewee’s Dean’s letter.

Hmm, organized the interest group…vaccinated babies in Africa..
High Pass
High Pass
Good, honors in psych
Remediated Peds? Guess I had better read the comments for that rotation….
High Pass
Overall an “excellent” candidate
Better look and see what that means
Top 15% “outstanding”, 80% are “excellent” well, that means almost nothing.

I once saw a school where 80% of their students were “Outstanding”. I wanted to tell them to look that one up in a dictionary.

 

[battleship888]

Grades are random sometimes but not most times. You have some control. I told everyone (attendings, residents, nurses, and techs) on my psychiatry rotations I wanted to do psychiatry, showed interest, read up on patients, polished my notes and did well on my shelf. Importantly, I got along well and treated everyone as a colleague and people made their desire known for me to do residency there and be a future colleague. Randomness cuts both ways too. I did well on surgery in spite of doing the minimum.

People with a 240 USMLE need to calm down too because SDN neuroticism is rampant.

I wouldn't call it neuroticism, but I see your point. Also, you can do all of those things and still get a crappy evaluation. That is just how this game works.

 

[clausewitz2]

Ok, time to review the interviewee’s Dean’s letter.

Hmm, organized the interest group…vaccinated babies in Africa..
High Pass
High Pass
Good, honors in psych
Remediated Peds? Guess I had better read the comments for that rotation….
High Pass
Overall an “excellent” candidate
Better look and see what that means
Top 15% “outstanding”, 80% are “excellent” well, that means almost nothing.

I once saw a school where 80% of their students were “Outstanding”. I wanted to tell them to look that one up in a dictionary.

How are they not going to stand out in those fetching short white coats among all the grown-ups?

 

[ziggyhope]

Ok, time to review the interviewee’s Dean’s letter.

Hmm, organized the interest group…vaccinated babies in Africa..
High Pass
High Pass
Good, honors in psych
Remediated Peds? Guess I had better read the comments for that rotation….
High Pass
Overall an “excellent” candidate
Better look and see what that means
Top 15% “outstanding”, 80% are “excellent” well, that means almost nothing.

I once saw a school where 80% of their students were “Outstanding”. I wanted to tell them to look that one up in a dictionary.

Lol, now that I've had the pleasure of looking at applications, this is too true.

 

[postbacpremed87]

Grades are random sometimes but not most times. You have some control. I told everyone (attendings, residents, nurses, and techs) on my psychiatry rotations I wanted to do psychiatry, showed interest, read up on patients, polished my notes and did well on my shelf. Importantly, I got along well and treated everyone as a colleague and people made their desire known for me to do residency there and be a future colleague. Randomness cuts both ways too. I did well on surgery in spite of doing the minimum.

People with a 240 USMLE need to calm down too because SDN neuroticism is rampant.

You're saying that it guarantees a match? If only...

 

[Merovinge]

You're saying that it guarantees a match? If only...

If you are a US MD that has no serious red flags and applies broadly with a comparable Step 2, it essentially guarantees a match. You really need much less to still all but guarantee a match in psych, the sky hasn't fallen that much.

 

[clozareal]

You're saying that it guarantees a match? If only...

I think that would guarantee a match if you are a US MD. I don't think it guarantees that you'll match into your top 3 though.

 

[postbacpremed87]

I think that would guarantee a match if you are a US MD. I don't think it guarantees that you'll match into your top 3 though.

Yeah I am a U.S. student but DO so a Step 1 of 239 doesn't guarantee anything.